How I Chose My Specialty — Surgical Specialties Panel

Are you curious about the process of choosing a medical or surgical specialty? Join our panelists on discussions of how/why they chose their specialty, what a day in their life entails, the highlights/frustrations of their field, and their unique professional journeys.

GENERAL SURGERY: Aduragbemi Ayeni, MD(Abrazo Health Network, Resident) Sarah Eidelson, MD (University of Miami/Jackson Memorial Medical Center, Resident) Constance Joel, MD (Eisenhower Army Medical Center, Resident)
NEUROSURGERY: Randaline Barnett, MD (University of North Carolina, Resident)
UROLOGY: Tolulope Bakare, MD (UT Southwestern, Attending)
OPHTHALMOLOGY: Cherilyn Mae Palochak, MD (Rosalind Franklin, Resident)
PLASTIC SURGERY: Kate Krucoff, MD (Medical College of Wisconsin, Attending) Chelsea Wallace, MD (University of Kentucky, Resident)
ANESTHESIOLOGY: Judy Gbadebo, MD (Lahey Hospital and Medical Center, Resident)

Moderators: Brette Harding (University of Missouri, Otolaryngology Resident), Samhita Nelamangala (University of Virginia, MS4)

Webinar recording is only available for AMWA members

Q & A: AMWA Surgical Specialties Showcase

Edited by: Samhita Nelamangala and Chung Sang (CS) Tse, MD

General Surgery

Can you match into general surgery and then pursue a more specialized surgical specialty or do you have to initially match into the specific field like plastics or neuro?

Absolutely. You can’t go into neurosurgery, OBGYN or ortho from general surgery but general surgery entails surgical oncology, vascular, endocrine, trauma, critical care, colorectal, plastics, pediatrics – these are all fellowships available to you after training.

Plastic Surgery

For plastics, do you choose a fellowship that is specific to the path you want to take (breast reconstruction, burns, etc.) or is that something you decide during the fellowship program?

For plastic surgery there are 2 paths: an integrated pathway (straight from medical school) or an independent pathway (after a general surgery, ENT, or ortho residency)

After completing residency fellowships are optional. But some surgeons decide to specialize in Hand, craniofacial, aesthetics, burn, microsurgery. And even if you do fellowship, you can still do procedures other than what you did in your fellowship. For example, I completed a hand fellowship but plan to do all kinds of surgeries including breast, general, etc.

Urology

Do you feel that it is harder to be a woman in urology than it may be in other specialties, just because the patient population is more male?

It’s not a big bias. In my experience, most men actually love female urologists.

Military Programs

For those in the military, what differences are there in surgery versus surgery in the civilian world (if there are any)?                   

In terms of case volume, we definitely meet all of the ACGME requirements! At my program, we spend about half of our time at outside rotations. One unique difficulty we face is deployment of our attendings – residents cannot deploy until we graduate residency. They have done a great job of back-filling attendings from other military hospitals and with reservists.

If I want to become a military physician, what are the steps necessary to do so?

I would reach out to current/previous HPSP scholars to ensure you can ask questions and figure out if it is the route for you. This is the most important part! Once you decide on if the lifestyle fits for you, you can easily contact a recruiter at a local office or online.

Is it possible to get into a military residency program if I’m not doing HPSP/ active military right now?

For military residency, you have to either be HPSP or at medical school at USUHS. You can always join later on (past M1), but civilians are not able to apply.

Could you talk about your decision to join the military and how that plays a role in your residency placement?

Part of my reason for becoming a doctor was to help veterans and active duty military. I grew up with many friends in the military and thought that they deserved the best medical care possible! It’s been very rewarding to treat a unique patient population that I would not have been involved with on the civilian side. With regards to residency, almost all students on HPSP scholarship will go to a military residency (this varies slightly between branches and specialties).

I wanted to help military families and veterans, which is a side of healthcare that others don’t see. I also think it is completely possible to match well, but you will still need to be competitive and sometimes patient if you don’t match the first time. Some people still match into their desired specialty after doing a flight/GMO tour and it requires some patience.

ENT

Do you have any insight on outpatient ENT practice and what that’s like in terms of cases and schedule?

ENT surgeons are very hard working, but when you’re an attending, and especially in a private practice setting, there is more flexibility to your schedule.  Many people will work in clinic 2-3 days per week, and the OR 1-2 days per week.  You can choose the type of surgeries to perform, such as tonsillectomies only, or have a very diverse practice of tonsillectomy, sinus surgery, voice surgery, some smaller head and neck cancer stuff, etc.  Many people do feel that ENTs have a great lifestyle.

Neurosurgery

Could you talk about work-life balance as a neurosurgeon, especially as a woman?

I think work-life balance is always a moving target. Some weeks will be a lot busier, and others will be easier. I think when you can plan for those easier weeks, make sure you’re spending your time doing things you love that can recharge you. When you’re going through tougher weeks, make sure you are completely present in the moment when you do get home. Turn off your phone. Turn off your pager unless you’re on call. Give your complete attention to your family or whatever activity you’ve decided to focus on that night that makes you happy. As you progress through training, it will become easier because in general, you take less call as you become more senior and you also become more adept at managing your time.

Anesthesia

What kinds of activities can I be doing right now to prepare to be an anesthesiologist?       

I would definitely recommend getting as much clinical experience as possible. The operating room milieu is very unique and getting an idea of the pace and culture can truly help you determine whether anesthesia is a good fit for you.

I’ve very interested in Anesthesia and have had many conversations with some of my classmates about mid-levels and job security around this specialty. What are your thoughts on this topic and should we be concerned?

Depending on whether or not you choose to work in academia vs a small community hospital vs a large company that distributes anesthesiologist to multiple hospitals will ultimately determine your work load. At this time, I do not have a concern about job security. Of course, you become more marketable the more diversified you make yourself. That’s where fellowship plays an integral role.

Work-Life Balance

How were you able to manage your mental health during medical school? Any tips to be able to manage stress as a med student and even as a pre-med?

Running was a huge form of stress relief for me in medical school and throughout residency. It was the only time of the day where I could completely clear my head. I think in order to maintain appropriate time management, I would choose one hobby or activity that makes you happy and relaxed, and make time for that activity each day.

Make sure you know your limits! Also have good outlets – running, hiking, having a wine night with friends, cooking, having a date night, etc.

Can you please expand a little more on having kids during residency? Are you allowed time off, and even with maternity leave do you still finish residency on-time? Thank you.

Plastic surgery just increased the maternity leave to 12 weeks without delaying graduation!

It is not easy to have a child in residency but it is totally possible! The key is to establish a village of help because ultimately residency is often long days and having someone you trust to help with your child is a must.

I worked with the ACGME/ABMS over the past three years to guarantee six weeks of leave for all parents, regardless of sex/gender without having to extend training. It finally passed a few months ago for ALL specialties. The times are changing!

How did you find a work-life balance in medical school and residency, especially in terms of spending quality time with your family, friends, and/or significant other?

I think it’s just making those things a priority. I tend to block out time for these things and don’t let anything else encroach on that time. When its family time, I don’t do work. And same for everything else. It is a lot of planning and shifting schedules but I think making those things priority really helps. Set study goals as well as boundaries for your own mental health and care.

Is it hard to develop a family life while being a woman in a surgical field? How do you know when it is a good time to have kids or start a life?

You’ll hear this answer a lot. There’s never a good time. I think when you feel like you’re ready, try to plan for as much as you can and go for it. It’s definitely not easy. Some days, you will feel like you’re being a bad mom or spouse and other days, you’ll feel like you’re coming up short as a resident. It’s just important to know that we all feel this way, and we all go through these struggles, which is why it’s important that we have venues to discuss these things.  My advice is when you are home and not on call, be completely present with your family. When you’re at work, be completely present at work and stay focused so you can do your best for your patients and be able to finish your work in a timely manner so you can go home to your family.

Research

In your specialty, how much of a role does research take in your career? Is doing academic research necessary as you get further in your careers?

It’s not necessary but always encouraged – there are tons of purely clinical surgeons that don’t do any research. There are some fields that would be very difficult to match into without research though- ie pediatric surgery, surgical oncology

I think it varies across specialties and programs. In neurosurgery, it tends to be highly encouraged. Most neurosurgery programs will have a built in research year, usually PGY-5. You’ll find programs that are more research intensive and may have up to two years of built in research time whereas other programs value it but may not emphasize it as much. In my program, in particular, our program director is passionate about making sure our 5th year is meaningful. For those who aren’t interested in research, they can pursue enfolded fellowships in a subspecialty of neurosurgery or even pursue academic interests like getting an MBA or MPH. I actually had minimal research prior to residency, but I became more interested as I progressed through training. I feel like I’ve had enough support in my program to feel comfortable coming up with ideas and facilitating my research projects.

Plastic surgery is hard to match into without some form of research. That being said, you only need to be a part of a few projects, not even first author. In residency, you are encouraged to do research, some programs emphasize this more than others. As an attending, you can choose to be in an academic setting (research encouraged where your clinical advancement can be tied to research productivity anywhere from 0-50% of your time). You can also go into hospital based settings or private practice where you do not need to do research.

Choosing a Surgical Career

Do you feel you must carry yourself and/or present yourself in any particular way to be respected in your particular field?

With confidence. It’s important to be professional even in an unprofessional environment. In essence, carry yourself the way you would appreciate seeing in others while remaining authentic and honest.

No matter your field-carry yourself with confidence. You have earned your spot. No need to be anything other than yourself!

How difficult did you find it to match into a surgical residency spot as a female, seeing as the field of surgery is so male dominated?

It is still male dominated but I think the field is changing and more welcoming to women. Our past 3 classes have been at least 50% women.

Personally, I don’t think it made things more challenging. If anything, being female, especially a female of color, helped me find mentors and network more easily. The field is changing. My class is all female and we’ve had amazing support from our attendings.

There are so many more female surgeons now! In my residency we were excited to have more female surgeons to bring balance to the group. There are more and more mentors out there each year too.

What is your best advice for an MS3 who still isn’t set on a specialty? How did you balance interest, lifestyle, training, etc. in making your decision?

Don’t think about what is going to happen in residency/fellowship when deciding about lifestyle in a particular specialty.  Residency and fellowship is always busy, no matter what specialty you choose! But it is a very brief period of your life and medical career.  So think about what the attendings are doing to give you a good idea of what a lifestyle might look like. Look at academic vs. private practice lifestyle of attendings.  And then figure out your goals and see which specialty matches up the best.  But to be honest, you can make your lifestyle what you want it to be.

Get as much exposure as possible! Talk to as many people in as many specialties as possible. Often times once you meet enough different physicians in many different specialties-you will find where your personality and interests fit!

What advice do you wish you had been given when choosing a specialty?

Shadow as much as possible and reach out to subspecialties if there’s any chance you think you might be interested. Unless you seek out subspecialties like urology you won’t get exposed in medical school!

With USMLE step 1 going pass/fail and most med school courses being pass/fail, what are things we can do to help ourselves stand out when applying to a competitive residency?

In plastic surgery, the letters of recommendation are really important- who writes them and how strong they are. If you come from a small program without a lot of “big name” surgeons, you could do an away rotation early in the summer to ensure that you get a letter from a well-known surgeon. You can also have some form of research experience- poster presentation, published article.

A follow-up question on gaining experience in smaller subspecialties, especially – Do you have any recommendations for networking and gaining exposure under the current COVID circumstances for a second year (pre-clinical)?

During COVID-19 restrictions many conferences for residency programs are being held via zoom. Reach out to see if you would be able to join zoom conferences.

Reach out to both academic and private practice settings. A lot of places are starting to allow shadowing again.